成人腰椎侧凸的多层螺旋CT研究
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摘要
第一部分成人腰椎侧凸与骨质疏松的相关性研究
目的：分析成人腰椎侧凸与骨质疏松的相关性
方法：收集自2011年1月-2011年12月就诊的腰椎侧凸患者100例作为病例组，其中男32例，女68例，年龄36~87岁，平均年龄64.5岁。对照组患者100例，其中男42例，女58例，年龄36~82岁，平均年龄62.8岁。所有患者均行腰椎CT检查确诊。通过计算机工作站的多种后处理功能分别测量两组患者椎体的体积，椎体的CT值及椎体骨小梁容积百分比（BV/TV），比较两组间的差异；重建骨小梁的三维图像，比较两组间骨小梁的形态、数目变化。
结果：腰椎侧凸组与对照组椎体CT值，BV/TV值的比较P<0.05，其差异具有统计学意义；椎体体积V的比较，P>0.05其差异不具有统计学意义。两组的骨小梁结构在3D-VR图像上显示，腰椎侧凸组患者骨小梁连续性中断，数目减少。BV/TV值与年龄经Pearson相关性分析，呈负相关。
结论：骨含量的下降，骨质疏松是成人腰椎侧凸发病的危险因素。随着年龄的增长，骨小梁的结构稀疏，数目减少。
第二部分成人腰椎侧凸椎间盘及腰椎小关节的临床特点
目的：评价成人腰椎侧凸与椎间盘的相关性及腰椎侧凸椎小关节的临床意义。
方法：收集自2011年1月-2011年12月就诊的成人腰椎侧凸患者100例，其中男32例，女68例，年龄36~87岁，平均年龄64.5岁，行腰椎CT检查，明确腰椎侧凸的诊断。测量椎间盘的不对称指数，分析研究椎间盘不对称指数与腰椎侧凸角度的相关性。观察测量关节突关节面的改变，关节间隙的改变、上下关节突的对位关系改变及伴随的椎间盘退变、黄韧带钙化、侧隐窝的变窄。
结果：凹侧四个椎间盘的高度和平均为44.62±0.77mm，凸侧平均为48.86±0.85mm，凹凸侧椎间盘高度比较差异有显著性（P<0.05）。椎间盘不对称指数的平均值为0.86±0.16，经Spearman相关性分析椎间盘不对称指数与侧凸Cobb角之间呈明显正相关性（P<0.05）。椎小关节的变化：关节突关节面的改变（90例），关节间隙的改变85例，小关节对合不良或者半脱位53例，伴随椎间盘退变、黄韧带钙化及侧隐窝变窄的变化79例。
结论：椎间盘退变的不对称性与成人腰椎侧凸的侧凸角度存在正相关。椎间盘退变和椎小关节退变相互促进，相互影响，是引起成人腰椎侧凸的重要原因。
Part1Correlative study of Adult lumbar scoliosis and osteoporosis
Objective: To investigate the correlation between adult lumbar scoliosisand osteoporosis.
Methods: From Jan.2011to Dec.2011,100patients diagnosed withadult lumbar scoliosis were included in the case group. There were32malesand68females with an average age of64.5years（ranging from36to87years）,control group had100cases without scoliosis. There were42malesand58females with an average age of62.8years（ranging from36to82years）. All the patients underwent lumbar-CT examinations to confirm thediagnosis. Through the computer workstation post-processing function, thevolume of vertebral body, vertebral CT value and vertebral bone trabecularbone volume percentage (BV/TV) of two groups of patients were measured,and the differences between the two groups were compared. withreconstruction of trabecular bone3D-image, the shape of trabecular bone andthe number change between the two groups were compared.
Results: By comparing the vertebral CT value and BV/TV value,significant difference was found among the lumbar scoliosis group and controlgroup (P<0.05), but the volume of vertebral body had no significant differencebetween the lumbar scoliosis group and control group (P>0.05). Thetrabecular bone structure of the two groups in3D-VR image was displayed,the continuity and amount of trabecular bone decreased in lumbar scoliosisgroup. According to the comparison of BV/TV value at different ages, theBV/TV value had a negative correlation with age.
Conclusion: Osteoporosis is a risk factor for adult lumbar scoliosis，Thecontinuity and amount of trabecular bone decreased with the increasing of age.
Part2Clinical characteristics of intervertebral disc and lumbarzygapophysis in adult lumbar scoliosis
Objective: To investigate the correlation between lumbar intervertebraldisc and adult lumbar scoliosis, and the clinical significance of vertebral smalljoints in adult lumbar scoliosis.
Method: From Jan.2011to Dec.2011,100patients diagnosed with adultlumbar scoliosis were included in the case group. There were32males and68females with an average age of64.5years (ranging from36to87years), all thepatients underwent lumbar-CT examination to confirm the diagnosis. Theintervertebral disc asymmetric index was investigated. The correlationbetween intervertebral disc asymmetric index and degrees of lumber scoliosiswere evaluated. The changes of articular surface and joint space, thecontrapuntal relationship of zygapophyseal joint, the degeneration of disc,calcification of ligament flavor and narrowing of lateral recess were observedand measured.
Results: The average intervertebral height was44.62±0.77mm in theconcave side and48.86±0.85mm in the convex side, which showedsignificant difference between the two sides（P<0.05）. The disc asymmetricindex was0.86±0.16,which showed positive correlation between discasymmetric index and degree of scoliosis （P<0.05）. The changes ofzygapophyseal joint were found to be varied such as subchondral facetsproliferation and sclerosis in90cases, changes of auricular cavity in85cases,the degenerative changes within lumbar also including little joint’s hemidislocation or abnormal alignment in53cases,and degeneration of disc,calcification of ligament flavor and narrowing of lateral recess in79cases.
Conclusion：The degree of scoliosis is positively related to the discasymmetric index. Disc degeneration and vertebral small joint degenerationare important causes of adult lumbar scoliosis.
目的：分析成人腰椎侧凸与骨质疏松的相关性
方法：收集自2011年1月-2011年12月就诊的腰椎侧凸患者100例作为病例组，其中男32例，女68例，年龄36~87岁，平均年龄64.5岁。对照组患者100例，其中男42例，女58例，年龄36~82岁，平均年龄62.8岁。所有患者均行腰椎CT检查确诊。通过计算机工作站的多种后处理功能分别测量两组患者椎体的体积，椎体的CT值及椎体骨小梁容积百分比（BV/TV），比较两组间的差异；重建骨小梁的三维图像，比较两组间骨小梁的形态、数目变化。
结果：腰椎侧凸组与对照组椎体CT值，BV/TV值的比较P<0.05，其差异具有统计学意义；椎体体积V的比较，P>0.05其差异不具有统计学意义。两组的骨小梁结构在3D-VR图像上显示，腰椎侧凸组患者骨小梁连续性中断，数目减少。BV/TV值与年龄经Pearson相关性分析，呈负相关。
结论：骨含量的下降，骨质疏松是成人腰椎侧凸发病的危险因素。随着年龄的增长，骨小梁的结构稀疏，数目减少。
第二部分成人腰椎侧凸椎间盘及腰椎小关节的临床特点
目的：评价成人腰椎侧凸与椎间盘的相关性及腰椎侧凸椎小关节的临床意义。
方法：收集自2011年1月-2011年12月就诊的成人腰椎侧凸患者100例，其中男32例，女68例，年龄36~87岁，平均年龄64.5岁，行腰椎CT检查，明确腰椎侧凸的诊断。测量椎间盘的不对称指数，分析研究椎间盘不对称指数与腰椎侧凸角度的相关性。观察测量关节突关节面的改变，关节间隙的改变、上下关节突的对位关系改变及伴随的椎间盘退变、黄韧带钙化、侧隐窝的变窄。
结果：凹侧四个椎间盘的高度和平均为44.62±0.77mm，凸侧平均为48.86±0.85mm，凹凸侧椎间盘高度比较差异有显著性（P<0.05）。椎间盘不对称指数的平均值为0.86±0.16，经Spearman相关性分析椎间盘不对称指数与侧凸Cobb角之间呈明显正相关性（P<0.05）。椎小关节的变化：关节突关节面的改变（90例），关节间隙的改变85例，小关节对合不良或者半脱位53例，伴随椎间盘退变、黄韧带钙化及侧隐窝变窄的变化79例。
结论：椎间盘退变的不对称性与成人腰椎侧凸的侧凸角度存在正相关。椎间盘退变和椎小关节退变相互促进，相互影响，是引起成人腰椎侧凸的重要原因。
Part1Correlative study of Adult lumbar scoliosis and osteoporosis
Objective: To investigate the correlation between adult lumbar scoliosisand osteoporosis.
Methods: From Jan.2011to Dec.2011,100patients diagnosed withadult lumbar scoliosis were included in the case group. There were32malesand68females with an average age of64.5years（ranging from36to87years）,control group had100cases without scoliosis. There were42malesand58females with an average age of62.8years（ranging from36to82years）. All the patients underwent lumbar-CT examinations to confirm thediagnosis. Through the computer workstation post-processing function, thevolume of vertebral body, vertebral CT value and vertebral bone trabecularbone volume percentage (BV/TV) of two groups of patients were measured,and the differences between the two groups were compared. withreconstruction of trabecular bone3D-image, the shape of trabecular bone andthe number change between the two groups were compared.
Results: By comparing the vertebral CT value and BV/TV value,significant difference was found among the lumbar scoliosis group and controlgroup (P<0.05), but the volume of vertebral body had no significant differencebetween the lumbar scoliosis group and control group (P>0.05). Thetrabecular bone structure of the two groups in3D-VR image was displayed,the continuity and amount of trabecular bone decreased in lumbar scoliosisgroup. According to the comparison of BV/TV value at different ages, theBV/TV value had a negative correlation with age.
Conclusion: Osteoporosis is a risk factor for adult lumbar scoliosis，Thecontinuity and amount of trabecular bone decreased with the increasing of age.
Part2Clinical characteristics of intervertebral disc and lumbarzygapophysis in adult lumbar scoliosis
Objective: To investigate the correlation between lumbar intervertebraldisc and adult lumbar scoliosis, and the clinical significance of vertebral smalljoints in adult lumbar scoliosis.
Method: From Jan.2011to Dec.2011,100patients diagnosed with adultlumbar scoliosis were included in the case group. There were32males and68females with an average age of64.5years (ranging from36to87years), all thepatients underwent lumbar-CT examination to confirm the diagnosis. Theintervertebral disc asymmetric index was investigated. The correlationbetween intervertebral disc asymmetric index and degrees of lumber scoliosiswere evaluated. The changes of articular surface and joint space, thecontrapuntal relationship of zygapophyseal joint, the degeneration of disc,calcification of ligament flavor and narrowing of lateral recess were observedand measured.
Results: The average intervertebral height was44.62±0.77mm in theconcave side and48.86±0.85mm in the convex side, which showedsignificant difference between the two sides（P<0.05）. The disc asymmetricindex was0.86±0.16,which showed positive correlation between discasymmetric index and degree of scoliosis （P<0.05）. The changes ofzygapophyseal joint were found to be varied such as subchondral facetsproliferation and sclerosis in90cases, changes of auricular cavity in85cases,the degenerative changes within lumbar also including little joint’s hemidislocation or abnormal alignment in53cases,and degeneration of disc,calcification of ligament flavor and narrowing of lateral recess in79cases.
Conclusion：The degree of scoliosis is positively related to the discasymmetric index. Disc degeneration and vertebral small joint degenerationare important causes of adult lumbar scoliosis.
引文
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2Lang T, Guglielmi G, Van KuilketvC, et al. Measurement of bone mineraldensity at the spine and proximal femur by volumetric quantitativecomputed tomography and dual energy X-ray absoptiometry in elderlywomen and without vertebral fractures. Bone,2002,30:247-250
3王亭,邱贵兴,李其一.CT三维重建在先天性脊柱侧凸诊疗中的价值.中华骨科杂志,2005,25:449-452
4Hedequist DJ, Emans JB.The correlation of preoperative three-dimensional computed tomography reconstructions with operative findingsin congenital scoliosis. Spine,2003,28:2531-2534
5Newton PO, Hahn GW, Ficka KB, et al. Utility of three-dimensional andmultiplanar reformatted computed tomography for evalution of pediatriccongenital spine abnormalities. Spine,2002,27:844-850
6Nakajima A, Kawakami N, Imagama S, et al. Three-dimensional analysisof formation failure in congenital scoliosis. Spine,2007,32:562-567
7Newton PO, Hahn GW, Ficka KB, et al. Utility of three-dimensional andmultiplanar reformatted computed tomography for evalution of pediatriccongenital spine abnormalities. Spine,2002,27:844-850
8Sucato DJ, kasaab F, Dempsey M. Analysis of screw placement relativceto the aorta and spinal canal following anterior instrumentation forthoracic idiopathic scoliosis [J]. Spine,2004,29(5):554-559
9Lang TE Summary of research issues in imaging and noninvasive bonemeasurement. Bone,2006,22(Supplement5):159-160
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